Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 38MC00242400 | NJ |
NPI | 1609925494 |
---|---|
Provider Name | Dr. Rosemarie Katherine Dziedzic |
First Address | Quakertown, PA 18951-3771 |
Second Address | Sicklerville, NJ 08081-2626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22-3023626 | (02) | NJ |